Healthy Weight Brief Interventions

Sara Dove & Sue Chant

Integrated Lifestyle Service

April 2014

What are the objectives of the training?

• Understand the basic elements of a healthy lifestyle brief advice input and brief intervention

• Provide opportunities to practice elements of a healthy lifestyle brief intervention, paying particular attention to raising the issue of weight

• Know the key messages relating to a healthy lifestyle brief intervention.

• Be familiar with and know how to use resources to support a healthy lifestyle brief intervention

• Know how and where to signpost locally to other services

Programme

• Background for this area of work• Defining Brief Interventions• Exploring the underpinning behaviour change theory• Revisiting the main healthy lifestyle messages• Practising brief interventions• Key health professionals • Referring on – what’s out there in Somerset?• Action planning• Close

Definitions

Underweight Healthy weight Overweight Obese

is the 2nd percentile or lower

is from above the 2nd to the 91st percentile

is from above the 91st to the 98th percentile

is above the 98th percentile

Definitions

Background

Statistics for Somerset Adults 2012

•Underweight = 0.5%

•Healthy Weight = 34%

•Overweight = 42.1%

•Obese = 23.4%

•Excess Weight = 65.5%

Influencing Factors

Health Risks

Links to Health & Wellbeing

Public Health England August 2013

How Healthy Behaviour Supports Children’s Wellbeing •Negative effects of excessive screen time and its link to conduct problems•Significance of family relationships and the positive influence that meaningful family activity (including regular meal times together) can have on the wellbeing of children and families•Significance of friendships and relationships between children at school and the negative influence of poor behaviour and bullying •Positive impact of physical activity across children’s wellbeing •Integrated nature of lifestyle behaviour and wellbeing.

What is a Brief Intervention?

• An opportunity for individuals to explore their lifestyle habits, which could impact negatively on their health.

• Involves opportunistic advice, discussion, negotiation or encouragement.

• Involves motivating and supporting people to change behaviour.

Recipients of brief interventions will be at various stages of ‘readiness to change’.

Every Contact CountsMaking the most of 5 minutes?

Every Contact Counts

…A few words given at the right time by the right person can have a significant influence…

What have you already tried?

• What do you already do?

• What seems to work?

• What do you find difficult?

The principles of client centred work

• The client is the expert about themselves

• The client is the decision maker

• The client has the right not to change

• The practitioner needs to demonstrate that they understand the clients point of view

Reflect on an experience when you decided you wanted to change

something.

•Why did you want to make that change?

•Did anyone or anything influence your decision?

•What plans did you make to bring about this change?

•Were you successful? If so, how have you maintained that change?

Engaging motivation to change

Each client has the potential for change.

The practitioner will build motivation by:• Demonstrating you believe they can change.• Setting high but realistic expectations of what they can

achieve• Using active listening skills• Using open questions

If a client has the motivation to changewhat do they need to move around the cycle?

• Client needs to value the benefits of the changed behaviour – needs to be important to them and a current priority

• Client needs knowledge/skills/confidence

• Important not to jump ahead of client’s readiness to change

Pre contemplation

Actions:•Suggesting possibility for change•Offering an opportunity to reflect•Offering information•Keeping the door open•Establishing rapport

Useful openings…

We’re offering everyone the opportunity to think about any changes they might want to make to work towards a more healthy lifestyle for you and/or your family. Is that something you’d be interested in?

What concerns do you have about your health or your families health?

As you can see your BMI/your child’s BMI is in the overweight / obese range. I’d be happy to talk with you more about how you feel about that.

Together, if you would like to, we can do something about your child’s weight.

Contemplation

Actions:•Building self esteem and confidence•Giving key health information messages•Weighing up pros and cons of change•Using scaling questions to explore confidence and importance

Useful phrases

What would be the benefits of making some lifestyle changes?

How important is it to you to make some changes? (Scale of 1 – 10) – why?

How confident are you that you will be able to make some changes? (Scale of 1 -10) – why?

Intervention is going well if:• You are being open and honest about your

agenda.• You are speaking slowly• The client is talking more than you• You are actively listening• The client is working hard and reflecting on

things themselves• You are negotiating behaviour change rather

than prescribing treatment.

Preparation and Action

Actions

•Continue to build confidence

•Use solution focussed interventions

•Remain positive

•Discuss goals and strategies

•Agree small changes – SMART GOALS

Solution Focussed Interventions

• Solution-building rather than problem-solving

• Focus on the client’s desired future rather than on past problems or current conflicts.

• Clients are encouraged to increase the frequency of current useful behaviours.

• Small changes lead to larger things

Solution focussed questioning

If those best hopes came true – what difference would that make to you?’

What would other people notice about you that was different?

What are you already doing to work towards this?

What are your best hopes for what you could achieve?

Solution focussed scaling• On a scale of 1 – 10 (10 being achieving your

best hopes) where do you think you are now?

• If you are a 4, what is an achievable goal?

• If you are a 4, why aren’t you a zero?

• What would you need to do to take it to a 6?

HELP MAKE A “SMART PLAN”Specific :- vague terms and are not useful and

can be confusing

Measurable:- how you will know when your goal is reached

Achievable:- do not impossibly high targets for yourself

Realistic:- you know yourself better than I do can you see yourself doing this

Time-limited: set a period in which this will be achieved

Talking about SMART goals

What is the first realistic

step you could take?

What has worked before that might make a good starting point?

You said you were on a scale of 4.

How could we make that a

5?

Maintenance

Actions:

•Keep checking in

•Offer positive feedback

•Continue to build confidence

•Review goals/set new ones

Useful phrases

If you’re really struggling we can think about more realistic goals?You seem to be doing

really well. What have you noticed that’s

changed?

Lapse/Relapse

Actions:

•Encouragement to have another go

•Reflect on learning from last attempt

Useful phrases

Next time you have go at

changing things you will know more about what works and doesn’t work.

I appreciate you’ve tried but found it really tough. If you like we can think about more

realistic goals or trying to achieve them

differently.

Key Health Messages

Key Health Messages

Physical Activity • Those not walking yet – restricting long periods in

baby seats, walking aids increasing play based activities

• Under 5’s walking – 180 minutes spread throughout the day

• 5-18 year olds – at least 60 minutes each day up to several hours

• 18+ - 150 minutes of moderate activity a week

Key Health Messages

Healthy Eating:

“Eat a balanced, variety of foods”• Consider portion size, age appropriate

• Snacking – healthy choices

• Reading food labels

Key Health Messages

• Limit screen time and time spent sitting• Smoking - “Stopping smoking is the greatest

thing you can do for your health”• Alcohol – Manage your unit intake

What makes a difference for adults?

• 5-10% weight loss with BMI 25-35 is required for a reduction in risk from Cardiovascular and metabolic disease

• 15-20% weight loss over (10kg) is required with BMI over 35 for a sustained improvement in comorbidities

• A weight loss of around 5kg in obese patients with type 2 Diabetes is associated with a reduction in Hb1c of 0.28% at 12 months

Starting from the same place

• Thorough assessment and consider the whole person

• Finding out what the patient wants to achieve

• Managing realistic expectations

• Diet, physical activity and lifestyle

Key Factors

• 60% Obese patients miss one meal a day• Snacking - all adds up….. 1 roses chocolate =

60kcals vs 1 apple 40kcals• Consider liquid calories from drinks• Writing down what’s eaten can help mindless

eating• Reducing portion size by 15% will result in

meaningful weight loss

Mindful Eating

• It takes around 20 minutes after eating for our brain to recognise we have had enough

• We miss these signals if we are distracted• Pausing before and after a mouthful helps to slow things

down and helps us recognise signals to tell us we are full.

• We can then stop eating, before we are too full

Helpful websites: www.nhs.uk/livewell www.weightlossresources.co.uk www.caloriecount.about.com www.weightconcern.org.uk www.diabetes.org.uk

Phone apps: Myfitnesspal Couch to 5K

Resources

• HENRY Courses• Cooking and Food growing courses ~

Somerset Community Food

• Community Pounds ~ community weight management initiative

Contact Details

Sue Chant ~ Integrated Lifestyle Service Manager 01935 846415 or sue.chant@sompar.nhs.uk

Sara Dove ~ Stop Smoking Service Manager

0303 0339840 or sara.dove@sompar.nhs.uk